Respiratory Physiology & OLV Flashcards
(178 cards)
1
Q
Choanal Atresia
A
obstruction of airway in obligatory nose-breathing newborns
-Choanal derives from Conchae/turbinates
2
Q
What level does the pharynx extend too & what does it become continuous with?
A
Extends to C6 & becomes continuous w/ esophagus
3
Q
Where might an ingested body most likely be found?
A
Level of C6
-Laryngopharynx from tip of epiglottis to C6 (beginning of esophagus)
4
Q
What level is the Larynx found in adults?
A
C3-C6
5
Q
What are the paired cartilages of the Larynx
A
Arytenoid
Corniculates
Couneiforms
6
Q
Narrowest part of adult airway
A
At Vocal Cords
7
Q
Narrowest part of pediatric airway
A
BELOW VC
8
Q
What muscle closes the vocal cords?
A
Aryepiglottic muscle
9
Q
What muscle opens the vocal cords?
A
Thyroepiglottic muscle
10
Q
What do the vocal cords attach to anteriorly?
A
Thyroid
11
Q
What do the vocal cords attach to posteriorly?
A
Arytenoids
12
Q
The RLN innervates ALL muscles of the larynx EXCEPT….
A
Cricothyroid & part of the interarytenoid muscles
13
Q
Unilateral damage to the RLN will present with…
A
Hoarseness
14
Q
Bilateral damage to the RLN will present with…
A
Dyspnea
15
Q
What are some causes of damage to the RLN?
A
Neck surgery, airway devices, regional anesthesia/blocks
16
Q
At what level is the carina?
A
T4-T5
17
Q
What is the estimated diameter of the trachea?
A
2.5cm
18
Q
How many centimeters are from the incisors to the larynx?
A
13 cm
19
Q
How many centimeters are from the larynx to the carina?
A
13 cm
20
Q
Total centimeters from incisors to carina? Relevance?
A
26 cm
-Subtract a few cm and where our ETT is to sit. Just above the carina.
21
Q
Which bronchi has the lesser degree angle? What degree?
A
Right bronchus. 25 Degrees. More likely to mainstem & food bolus
22
Q
What innervates the bronchi? (2)
A
Sympathetic & vagus nerves
23
Q
Function of Type 1 Pneumocytes
A
Structure
24
Q
Function of Type 2 Pneumocytes
A
Produce surfactant that reduce alveolar collapse
25
Function of Type 3 Pneumocytes
Macrophages
26
What physical law/gas law is represented by the mechanics of inspiration?
Boyle's Law
-Volume & Pressure inversely proportional @ constant temperature
27
Which nerve innervates the diaphragm & what is its origin?
Phrenic = C3-C5
"Keeps the diaphragm alive"
28
Lung compliance
change in volume / change in pressure
29
What 6 components may decrease Static Compliance?
1. Fibrosis
2. Obesity
3. Vascular engorgement
4. Edema
5. ARDS
6. External compression
30
What is the ONLY component that INCREASES Static compliance?
Emphysema
31
What is the normal range in mL/cm H2O for Static Compliance?
60-100 mL/cmH2O
32
What is Static Compliance?
***Compliance of JUST the lungs & chest wall
**Useful evaluating conditions that affect lung parenchyma or chest wall
-Measured when no air moving in lungs
33
Static compliance decreases with fibrosis, ARDS, pulmonary edema which makes it more difficult for the lungs to ___________
Expand
34
Why does the Law of LaPlace not apply to the lungs/alveoli?
Because of the surfactant produced by type II pneumocytes.
** Aids in lowering alveolar surface tension = prevents collapse
-Phospholipid dipalmitoyl lecithin"
35
What role does surfactant have in the lungs & alveoli?
*Aids in lowering alveolar surface tension = preventing collapse
*Lowering surface tension in smaller alveoli prior to large to prevent from collapsing/emptying into large
36
At what age gestation is surfactant produced?
28-32 weeks
*Produced fully at 35 weeks
37
Define Law of LaPlace
At constant surface tension
-Pressure increases & radius decreases
Pressure & radius inverse relationship
38
Reynolds number >4000 indicates
Turbulent flow
39
Reynolds number <2000 indicates
Laminar flow
40
Is laminar flow seen more in smaller airways or larger airways?
Smaller airways
41
40% of airway resistance is in the __________ airways. Consisting of.... (3)
Upper airways have more resistance --> greatest resistance is in medium sized bronchi
**Bends = increase resistance
-Nasal cavity, pharynx, larynx
42
What physical law describes a resistance to laminar flow?
Poiseuille's Law
43
Ill Tell Eddie Rabbit IF Victor Rabbit Tells
50-10-20-20
44
Obstructive lung diseases have _______ resistance
Increased resistance which restricts airflow through airways
*Gas trapping leads to blebs = barrel chest & increased lung volumes
-Increased/prolonged exhalation time
45
Restrictive lung disease have decreased ________ & ________
compliance & volumes
-Fibrosis, scoliosis, obesity, pregnancy etc
46
FEV1
80% of vital capacity can be exhaled in 1 second
47
Closing volume
Amount of air left in the alveoli at the moment they begin to collapse (expiration after small airways close)
48
What happens if the closing volume is greater than functional residual capacity?
Airways collapse & can no longer participate in gas exchange but still receive blood flow.
*Intrapulmonary shunt develops = more at risk for hypoxemia
49
Although the elastic recoil of surrounding tissues help keep alveoli expanded, the alveoli ar PRIMARILY DEPENDENT on _______________ to keep them open
Lung Volume
50
What is Closing Capacity?
closing volume + residual volume
51
What happens if the FRC is greater than CC?
Airways stay open
52
What happens with closing capacity as we age?
Typically increases
-44yo --> CC & FRC = in supine position
-65yo --> CC & FRC = in upright position
-Closing volume increases up to 55% at 70yo
53
What pulmonary conditions have an increased closing capacity?
Asthma, COPD, pulmonary edema
54
Anatomic dead space
volume of conducting airways/thickened walls with NO gas exchange
-2mL/kg
55
Alveolar dead space
Alveoli that are ventilated but NOT perfused
-Calculated using Bohr's equation
56
Regarding alveolar dead space & Bohr's equation, what is the total surface area for gas exchange?
Total surface area for gas exchange is 60-80 m2
57
What is PACO2 inversely proportional to?
Alveolar ventilation
-Yet as alveolar ventilation increases, PAO2 increases slightly but does not work in the parallel fashion
58
How many bronchial arteries are there?
1 right
2 left
59
Why is the pulmonary vascular resistance (PVR) an estimated 1/8 (12.5%) of SVR?
Short vessels, decreases resistance
***Poiseuille's Law
-Can increase PEEP as long as no cardiac compromize to improve gas exchange
60
Bronchopulmonary Anastomose
-Normal anatomic shunt where deoxygenated blood from right trickles into the left side of the heart = mixing of oxygenated & deoxygenated blood
***Clinical significance --> bypass needs a left atrial drain to avoid over distension of the drained deoxygenated blood ??????
61
Pulmonary blood flow is "opposite" of systemic circulation. Why?
High O2 tension & hypocapnia increase blood flow via vasodilation = increases O2 uptake
-Hypercarbia & acidosis cause vasoconstriction
62
Hypoxic Pulmonary Vasoconstriction (HPV)
Protective mechanism that occurs during hypoxia where blood is diverted from hypoxic/atelectatic alveoli to precapillary site to improve V/Q
63
Volatile anesthetics & hypoxic pulmonary vasoconstriction
Volatile anesthetics inhibit HPV @ ~1.5 MAC
64
West zone 1 in upright lung
-Alveolar dead space
-Alveoli are ventilated but NOT perfused
-A > a > v
* V/Q > 1
65
West zone 3 in upright lung
*Dependent
-Continuous blood flow because fluids take path of least resistance/gravity
-Tip of PA catheter = communication w/ left heart
-a > v > A
*V/Q <1 = SHUNT because blood is flowing past but cannot ventilate
-"Direct column of blood between RV & LA"
66
West zone 2 upright lung
Continually changing bc of alveolar & vascular pressure changes
*V/Q ~ 1
67
Pulmonary Edema
Colloid & oncotic pressures messed up = things leak into interstitium or alveoli
***Disrupts gas exchange by increasing the space for allowed gas exchange
**O2 effected >>> CO2 bc CO2 is 20x more diffusible
68
Neurogenic pulmonary edema
Often caused by an increase in sympathetic discharge. More chemical in nature.
ex) TBI
69
Negative Pressure Pulmonary Edema (NPPE)
Forced inhalation against a closed glottis
*Acute decrease in intrathoracic pressure pulls fluid from the pulmonary capillaries
70
Why should you consider giving steroids in the treatment of Pulmonary Edema?
Membrane Stabilizers & antiinflammatory properties
71
Why might morphine be used in the treatment of pulmonary edema?
Can reduce preload & has pulmonary vasodilating properties
72
Ventilation but NO Perfusion
Dead space
-"Not defined or infinity"
73
Ventilated but POOR perfusion
Shunt
74
Increased or high airway pressures effect ventilation & perfusion how?
Alveoli may be ventilated but not perfused because so much pressure the pulmonary vasculature become "squished" which decreased blood flowing past.
*Low cardiac output states = low pulmonary blood flow = dead space
-ETCO2 & PACO2 gradient increases
75
In supine position with GA, what causes the atelectasis & 10% shunt?
-Decreased FRC
-PPV (although more uniform ventilation) there is a decrease in CO
-Drop in CO (likely preload)
PEEP
76
Each gram of Hgb can combine with how many mL of O2?
1.34 mL of O2 = Hgb Carrying Capacity
77
What scant amount of O2 is dissolved in blood?
0.003 mL of O2/ 1mmHg of PO2 in 100mL of whole blood
78
A shift right in the oxyhemoglobin dissociation curve does what? Why? In what states?
Releases O2
Tissues need it
Often increased metabolic states
79
Bohr Effect
Influence of pH and PCO2 on oxyhemoglobin dissociation curve
*BohR = shifts right to RELEASE O2
80
What is methemoglobinemia caused by? (2 factors). What state is the iron in?
Nitrate overdose (NTG) or locals (prilocaine, benzocaine)
-FerriC = Fe3+
81
Methylene blue dosage
"Methylene Blue = 1 to 2"
* 1-2 mg/kg over 5min
82
80-90% of CO2 is transported via_____
Bicarbonate Ions
83
The Haldane Effect shifts the oxyhemoglobin dissociation curve to the __________?
HaLdane = LEFT
-Holds on to O2 molecules
84
Caution correcting respiratory acidosis with NaHCO3 in mechanically ventilated patients. Why?
Can worsen acidosis d/t an increase in CO2
-HCO3 + H2O dissociates into CO2
85
At what pH would you consider treating metabolic acidosis with NaHCO3?
Only if pH <7.20
-Use base deficit to determine extent of resuscitation needed = total bicarbonate deficit
86
Base deficit
-Indicator/value to degree of metabolic acidosis
- aka Total body Bicarbonate Deficit
-Often from hypovolemia
87
Base deficit total correction calculation
Normal Bicarb - Base Deficit x kg x 0.3
ex) (24-10)(0.3)(80kg) = 336 meq/L
88
Bicarbonate replacement guidelines in metabolic acidosis
-Calculate total correction needed
-Replace 50% over first 3-4hrs
-Replace additional 50% over next 6-12hrs
89
Why must one be cautious fluid resuscitating/correcting metabolic acidosis w/ crystalloids & or/ NaHCO3?
-Hyperchloremic metabolic acidosis
-Increased CO2 from Henderson Hassalbach equation
90
Herring Breur Reflex: Inflation
Prevents over distension of alveoli & transient apnea
91
Herring Beur Reflex: Deflation
Increased ventilation when lungs are deflated abnormally
*Clinical ex = Pneumothorax
92
Paradoxical reflex of Head
Partial block of phrenic nerve = deeper breath instead of apnea
*Clinical ex = Baby's first breath
93
Hering nerve
Afferent nerve from Carotid Body
-Branch of Glossopharyngeal nerve (CN9)
94
What are the 3 causes of decreased FEV1 (progressive airflow obstruction) in COPD?
1. Decreased intrinsic size of bronchial lumen
2. Increased collapsibility of bronchial walls
3. Decreased elastic recoil
95
Moderate IIA COPD classification
FEV1/FVC >/= 70%
FEV1 <50 %
**Only class that will have an increase FEV1/FVC ratio >70%
96
Severe COPD classification
FEV1/FVC <70%
FEV1 <30%
Presence of right sided or respiratory failure
97
How do opiates & anesthetics affect minute volume & PaCO2?
Decrease Ve
Increased PaCO2
98
What is present in 2/3 of severe COPD patients that can be seen on arterial BP monitoring?
Pulsus Paradoxus
-Drop in >10mmHg with inspiration
*R/t severe airflow obstruction, increased intrathoracic pressure = decrease in preload & CO
99
What does a low FEV1 correlate with in a pulmonary assessment?
Coronary Artery disease & increased mortality
100
What FEV1 value would indicate the need for pulse oximetry & ABG evaluation which may require postop ventilation (discuss & document)
FEV1 <1.5L
101
Why might nitrous oxide be contraindicated in COPD?
Bullae rupture
-Remember nitrous oxide is highly diffusible & rapidly fills air-filled spaces
102
COPD induction & emergence concept
Longer induction & emergence r/t slower gas exchange
103
High or low tidal volume in COPD patients?
Higher Vt supports increased gas exchange
104
Capnograph phase 1
Anatomical dead space ventilation
105
Capnograph phase 2
Dead space mixed w/ alveolar ventilation
106
Capnograph phase 3
Alveolar ventilation (where ETCO2 measured)
107
Capnograph phase 4
End of exhalation & start of inspiration
108
Downsloping of phase III capnograph means what possible pathology?
Severe emphysema
-Alveolar destruction can cause rapid initial emptying of CO2
109
Prolonged Phase II/III with widened alpha angle on capnograph. Resembles a "shark fin."
Bronchospasm
Airway obstruction
COPD
110
Cardiac oscillations during IV capnograph may indicate
-Hypovolemia
-Hypoventilation
-Each heartbeat ejects a small amount of CO2
111
Curare cleft on capnography
Usually seen as rapid "hiccup/down spike" during phase III of capnograph.
- Patient desynchrony during mechanical ventilation & trying to breathe
112
Prominent phase IV with terminal upswing on the capnograph may indicate
Obesity
Pregnancy
Poor compliance
113
Capnograph does not return to baseline
Rebreathing effect
114
Sudden drop in ETCO2 in capnograph
-Displaced ETT
-Decreased CO (arrhythmia, PE, etc.) = bc if blood is not pumping well to lungs, there is reduced delivery of CO2 to lungs & thus little gas exchange occurring & therefore a drastic decrease in exhaled CO2
115
Why is PETCO2 usually less than PaCO2?
Dead space
*Alveolar : arterial gradient
116
____________________ measures exhaled CO2 content & displays results graphically.
IR Spectroscopy
117
Brief pathogenesis of Asthma & what it results in
Inflammation of the airway with non-specific hyperirritability of the tracheobronchial tree
**Result = airflow limitation
118
Pulmonary function test (PFTs) for asthma
***Both decreased
-Decreased FEV1
-Decreased FEV1/fvc ratio
-FEV 25-75%
-Normal FEV = 4-5 L/sec
119
What would an ABG & ECG show with asthma?
-Respiratory alkalosis
-ECG = ST changes, RV strain, RV deviation
120
Sputum Eosinophilia with Curschmann spirals & Charcot-Leyden crystals is diagnostic of what respiratory disease?
Asthma
121
Elevated peak pressures & increased PPV in asthma can cause...
Barotrauma, pneumothorax, lung hyperinflation, air trapping
122
Alveolar distension in asthmatics causes this cascade...
Decrease in venous return
-With impaired ventilation --> increased PVR & RV afterload = leading to hemodynamic collapse
123
Asthma preop anesthesia management pearls
-Review PFTs & asthma control = use of inhalers w/in last 6 mo
-If on corticosteroids --> give preop steroids = 100mg hydrocortisone q8h
-Consider atropine or glycopyrrolate for bronchodilation. Ketamine may be nice adjunct
-Anxiolysis important = friend
-Inhalers before surgery
-Quit smoking >8 weeks so cilia can return back to normal function
124
What intraoperative meds should be avoided in asthmatics?
-Histamine releasing agents (thiopental, morphine, etc)
-ISO & DES d/t mild irritation
-Beta Blockers (esmolol/labetolol) r/t bronchoconstriction
-Toradol avoidance in ASA induced asthma patients
-Avoid H2 blockade d/t prolonged NMBAs
125
Intraoperative asthma exacerbation anesthesia management
Deepen anesthetic
FiO2 100%
B2 agonist up to 10 puffs
IV or SQ epi for severe tx
Hydrocortisone 2-4 mg/kg
IV aminophylline if long term vent only
126
Pulmonary HTN diagnostic pressures
PASP >30 mmHg
PMAP >20 mmHg
127
Why might pulmonary HTN cause chest pain?
-Increase in RV myocardial O2 demand
-Decrease in coronary blood flow
128
ECG changes & CXR findings with pulmonary HTN
RA hypertrophy = tall/peaked P-waves >2.5mm in anterior & inferior leads --> II, III, aVF = P-pulmonale
-RV hypertrophy
CXR = Dilated Pulmonary Artery
129
Gold standard assessment/diagnostic of pulmonary HTN
****Cardiac cath + PA angiography
-Right-sided heart catheter w/ swanz
130
What anesthetic agent in particular do you want to avoid with pulmonary HTN & why?
Avoid ketamine d/t it increasing pulmonary vascular resistance = worsening PAH
-If severe enough, can lead to RHF
131
Cor Pulmonale definition
Pulmonary HTN w/ RV hypertrophy, dilation, & cardiac decompensation
-Sustained increase in PVR
-RV failure
Dx w/ right heart cath & pulm angio
132
Cor Pulmonale signs & symptoms
***Right heart failure
-Cardiac heave or thrust & LSB
-S3 gallop d/t fluid overload
-S4 r/t RV hypertrophy
-Wide split S2
-Pulmonic +/- tricuspid regurg
-ECG = RA enlargement + displacement, RVH
-Can develop SVT, A-fib, ST, PAT
-CXR = pulmonary arteries enlarged +/- RVH
-Backflow of fluid = JVD + edema in those places + hepatomegaly
133
Pulmonary Embolism
Collective term for entry of blood clots, fat, tumor cells, air, amniotic fluid, or foreign material into venous system
-90% from DVT
134
Virchow's Triad
Hypercoagulability + Vascular Damage + Circulatory Stasis
135
Virchow's factors of hypercoagulability
**Estrogen therapy, inflammation, dehydration
-Major surgery/trauma
-Malignancy, autoimmune condition, inherited thrombophilia
-Post-partum
-Infection & sepsis
-IBD
136
Virchow's factors of vascular damage
**Physical trauma, strain, injury,
**Microtrauma to vessel wall
-Indwelling catheter/heart valve
-Venepuncture
-Atherosclerosis
-Thrombophlebitis
-Cellulitis
137
Virchow's factors of circulatory stasis
** Bradycardia & hypotension
**Congenital venous anatomy abnormalities (May-Thurner & Paget-Schroetter syndrome)
-A-fib or LV dysfunction
-Venous obstruction d/t obesity, tumor, pregnancy
-Vericose veins
138
Surgical procedures with greatest incidences of perioperative PE
1. Hip fracture repair & THA
2. Acute SCI
3. Trauma
4. TKA
5. Thoracic
6. General Surgery
139
Patho of Pulmonary Embolus
Whether obstructive or neurohumoral (chemical), the cascade begins with pressure load. This increases wall tension & O2 demand with a decrease in RV coronary perfusion pressure (CPP) leading to ischemia, RV decompensation, and decreased RV output. RV volume increases d/t its inability to pump forward effectively, shifting the IV septum & restricting the pericardium leading to a decreased LV distensibility. LV preload drops which decreases CO & MAP further worsening RV coronary perfusion pressure.
140
Mechanism of why/how a PE causes hypoxemia
Decreased CO & Increased dead space
-Increased PA pressure --> decreased HPV, transudate fluid = decreases FRCC & CC
-PLT & serotonin activation --> increases capillary permeability = decreases FRC & CC
-Serotonin causes bronchoconstriction = decreases FRC & CC & hypoventilation
141
4 primary reasons of hypoxia in PE
-Decreased CO
-Decreased HPV
-Decreased FRC-CC
-Hypoventilation
142
What is the most accurate/definitive diagnostic of PE
Helical CT scan
& TEE
143
Acute intrinsic restrictive pulmonary disease
Edema, aspiration, ARDS
144
Chronic intrinsic restrictive pulmonary diseases
Fibrosis, radiation, auto immune, O2 toxicity, sarcoidosis
145
Chronic extrinsic restrictive pulmonary diseases
Flail chest, pneumo, atelectasis, effusion
146
Pulmonary Edema Treatment
O2, PEEP, Vasodilators, Inotropes, Steroids, Diuretics
-Maybe morphine to decrease preload
147
Mendelson's syndrome
*Chemical pneumonitis
-Acid pH <2.5, highly particulate, large volume >25 mL
148
Why might lidocaine be used in the treatment of aspiration?
Lidocaine inhibits neutrophil response
149
ARDS causes damage to...
Alveolar capillary membrane
-release of cytokines & phospholipids from capillary endothelium
150
ARDS & Anesthesia
-Use ICU vent if anesthesia machine cannot handle ventilation
-Caution barotrauma
-Hypovolemia --> foley for fluid status
-Invasive lines
151
Bleomycin tx r/t interstitial fibrosis
-O2 & ABG monitor
-100% FiO2 for only 4 min prior to induction
-Low FiO2 AFTER intubation
-PEEP
-Judicial use of IV fluids
-May need postop vent
-Postop FiO2 down
152
Sarcoidosis
-Decreased lung compliance
-Decreased diffusing capacity
-Reduced lung volumes
***Pulmonary involvement in 90%
153
Flail chest
Multiple rib fractures
**Paradoxical movement at site of fracture
-Can have trauma BEHIND fractures (pulmonary contusions). Decreased Vt r/t pain --> thoracic epidural would be helpful. Maybe intercostal nerve blocks
154
Communicated Pneumothorax
-Communicated w/ Atmosphere
-Lung collapses on inspiration & extends slightly with expiration
**Place occlusive tissue on
155
Tension pneumo
Shifts trachea to opposite side
**16-18g needle decompression @ anterior mid-clavicular line
156
Does general anesthesia contribute to atelectasis?
Yes. Use PEEP and recruitments
-30 cmH2O for 10 seconds
157
What other conditions are often seen with Pectus Carinatum?
Heart defects = VSD, PDA, ASD, MV
158
A cobb angle greater than ____________ in kyphoscoliosis will produce pulmonary symptoms
Cobb angle >60-70
-Reduced lung volumes & chest wall compliance
159
Ankylosing spondylitis pearls
-Restrictive lung pattern
*****Limited cervical neck movement
-Affects c5-c7 the most
160
The 4 M's primarily for thoracic cancer treatment
-Mass effects
-Metabolic events = lambert-eaton syndrome, hypercalcemia, hyponatremia, cushing syndrome
-Metastases
-Medications
161
Two factors of thoracic surgery that contribute to postop morbidity & mortality?
Respiratory = atelectasis, pneumonia, respiratory failure
-Cardiac complications = arrhythmia, ischemia
***Focus on preop assessment & risk stratification
162
Single best test for lung mechanics in thoracic surgery
Predicted postoperative forced expiratory volume in 1 sec (ppoFEV1%)
**High risk <30%
163
Diffusion Lung Capacity (DLCO)
Used to determine gas exchange capacity
*** <40% = higher pulmonary & cardiac risk
164
Lung parenchymal function values
PaO2 >60
PaCO2 <45 mmHg
165
Highest predictor of cardiopulmonary interaction
Stair climbing
-NOT most formal
166
Most formal & gold standard of cardiopulmonary interaction
maximal O2 consumption (VO2)
167
Fluid management in thoracic cases
Conservative. <500-1,000 mL
168
In lateral position, where should A-line, pulse oximeter, and frequent pulse checks occur?
Dependent/down arm
169
PEEP to dependent lung during tx of hypoxia in OLV will....
-Can cause shunt to non-dependent lung
-Can decrease CO
170
Early ligation or clamp to nondependent pulmonary artery for tx of hypoxia during OLV will ....
Shunt blood from nondependent to the dependent, ventilated lung
171
Which lung to give CPAP during tx of hypoxia under OLV?
CPAP to non-dependent (upright) lung
-Start at 2 cmH2O
172
After back on 2 lung ventilation, important to do this with the DLT...
Dop bronchial (blue) cuff to decrease risk of bronchial necrosis
173
Cryoablation for thoracic surgery can lead to ...
postop thoracotomy pain syndrome
174
Tumors of the mediastinum
Thymoma, thyroid mass, teratoma, lymphoma
***Can compress airways & vital cardiac structures
175
Mediastinal mass can cause__________ at any time throughout anesthetic process
Airway collapse
176
What position to induce patient for anesthesia who has a mediastinal mass?
Induce sitting upright
177
Critical to perform preoperatively in patient with mediastinal mass
****Review CT scans, MRI, or any radiographic findings prior to any anesthesia or airway interventions
178
Want to keep patient with mediastinal mass _____________________
Spontaneously ventilating
